Publications by authors named "Kishore Sandu"

40 Publications

Intubation Related Laryngeal Injuries in Pediatric Population.

Front Pediatr 2021 10;9:594832. Epub 2021 Feb 10.

Head and Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Laryngeal intubation related lesions (LIRL) in pediatric patients cause extreme morbidity in both elective and emergency settings. It has a wide range of presentations from minor laryngeal edema to a life-threatening airway obstruction. We report here our units' experience with LIRL in neonates, infants, and small children. This is a retrospective monocentric cohort study between January 2013 and April 2019. Thirty-nine patients with intubation lesions were included in the study. We looked at the lesions type, characteristics, management, and outcome. Half the patients were premature and having comorbidities. Main LIRL were subglottic stenosis (31%), ulcers (26%), granulations (18%), retention cysts (18%), posterior glottic stenosis (13%), and vocal cords edema (5%). Unfavorable lesions causing airway stenosis were associated with an intubation duration of over 1 week and were an important factor in causing airway stenosis ( < 0.05). The endoscopic treatment performed for these lesions was lesion and anatomical site-specific. Tracheostomy was needed in five patients, and was avoided in another two. Seven patients (18%) received open surgery prior to their decannulation. LIRL management is challenging and stressful in the pediatric population and optimal treatment could avoid extreme morbidity in them. Intubation duration and associated comorbidities are important factors in deciding the severity of these lesions. Protocols to prevent the formation of these lesions are critical.
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http://dx.doi.org/10.3389/fped.2021.594832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902727PMC
February 2021

International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation.

Int J Pediatr Otorhinolaryngol 2021 Feb 15;141:110565. Epub 2020 Dec 15.

Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Objectives: To provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients.

Methods: An iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group.

Results: Twenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation.

Conclusion: Tracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.
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http://dx.doi.org/10.1016/j.ijporl.2020.110565DOI Listing
February 2021

Outcomes of balloon dilation for paediatric laryngeal stenosis.

Acta Otorhinolaryngol Ital 2020 Oct;40(5):360-367

Airway Sector; Department of Otolaryngology, Lausanne University Hospital CHUV, Switzerland.

Objective: Balloon dilation (BD) is a minimally invasive endoscopic treatment for paediatric laryngeal stenosis (LS) with reduced morbidity compared to open surgery. We retrospectively describe our experience in a cohort of children with chronic LS.

Methods: Fourteen children (median age: 28.5; range: 2-81 months) with chronic LS (multilevel in 8) were treated with tubeless total intravenous anaesthesia under spontaneous ventilation.

Results: Grade III LS was preoperatively detected in 12 children; the remaining 2 had grade IV stenosis. Six had prior tracheotomy, and one received it during the first intervention. Dilation laryngoplasty was the primary treatment in 11 children and was used as an adjuvant treatment in 3 after open reconstructive surgery. The median number of dilations was 2 (range: 1-6). There were no postoperative complications. At the end of the follow-up (median: 20.5; range: 2-46 months), detectable laryngeal lumen widening and/or respiratory improvement occurred in 12 children. Two of 7 patients with tracheostomy were decannulated.

Conclusions: Balloon laryngoplasty is a valuable therapeutic option to improve laryngeal patency in children with chronic multilevel LS, both as a primary and secondary adjuvant treatment after reconstructive surgery.
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http://dx.doi.org/10.14639/0392-100X-N0830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726638PMC
October 2020

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Management of suprastomal collapse in the pediatric population.

Int J Pediatr Otorhinolaryngol 2020 Dec 13;139:110427. Epub 2020 Oct 13.

Children's Health Ireland (Crumlin), Dublin, Ireland.

Introduction: Suprastomal Collapse (SuStCo) is a common complication of prolonged tracheostomy in children. There is a paucity of literature on this subject, especially regarding how to manage significant suprastomal collapse that prevents safe decannulation.

Objective: Provide a definition, classification system, and recommend management options for significant suprastomal collapse in children with tracheostomy.

Methods: Members of the International Pediatric Otolaryngology Group (IPOG) who are experts in pediatric airway conditions were surveyed and results were refined using a modified Delphi method.

Results: Consensus was defined as > 70% agreement on a subject. The experts achieved consensus: CONCLUSION: This consensus statement provides recommendations for medical specialists who manage infants and children with tracheostomies with significant Suprastomal Collapse. It provides a classification system to facilitate diagnosis and treatment options for this condition.
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http://dx.doi.org/10.1016/j.ijporl.2020.110427DOI Listing
December 2020

[Laryngeal reinnervation].

Rev Med Suisse 2020 Oct;16(709):1845-1848

Service d'ORL et de chirurgie cervico-faciale, CHUV, 1011 Lausanne.

The surgical management of unilateral and bilateral vocal cord paralysis depends on the severity of the condition, the potential for spontaneous recovery, the patient's age and vocal expectations. Standardized re-innervation surgeries, unilateral non-selective and bilateral selective, are viable alternatives to static procedures currently under evaluation in prospective studies. Neurorraphy of the ansa cervicalis loop to the recurrent laryngeal nerve allows lasting vocal recovery and potentially superior results to medialization and thyroplasty, by maintaining the visco-elastic properties of the vocal cord and preventing its atrophy. Selective bilateral reinnervation shows potential for recovery of inspiratory abduction with improved respiratory function without vocal deterioration.
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October 2020

Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society.

Eur Arch Otorhinolaryngol 2021 Jan 6;278(1):1-7. Epub 2020 Jun 6.

Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.

Introduction: The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae.

Materials And Methods: This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers.

Results: A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context.

Conclusions: One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers.
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http://dx.doi.org/10.1007/s00405-020-06112-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275663PMC
January 2021

[Congenital tracheal stenosis: from clinic to treatment.]

Rev Med Suisse 2019 Oct;15(665):1765-1768

Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, CHUV et Université de Lausanne, 1011 Lausanne.

Congenital tracheal stenosis is a rare malformation of the fibrino-cartilaginous tracheal skeleton, frequently associated with cardiac malformations. The symptoms and the age of presentation varie according to the severity of the stenosis. There is a risk of airway obstruction. The diagnosis is based on endoscopy and surgery is usually required.
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October 2019

Role of Unilateral Vocal Cord Palsy in Causing Recurrent Tracheobronchial Foreign Bodies.

Front Pediatr 2019 24;7:282. Epub 2019 Jul 24.

ENT Head and Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Foreign body (FB) aspiration in children is a frequent condition managed by ENT pediatric surgeons and pediatric pulmonologists. We present the case of a 20-months-old child who presented with three recurrent episodes of FB aspiration. At the time of FB removal, an initial dynamic examination of the larynx revealed a unilateral vocal cord palsy (UVCP). For recurrent tracheobronchial FB inhalation, we recommend a systematic dynamic airway endoscopy.
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http://dx.doi.org/10.3389/fped.2019.00282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668050PMC
July 2019

Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants.

Laryngoscope 2020 04 27;130(4):E199-E205. Epub 2019 Jul 27.

Department of Otorhinolaryngology and Head & Neck Surgery, University of Szeged, Szeged, Hungary.

Objectives: Subglottic stenosis is the most common laryngeal anomaly necessitating tracheostomy in early childhood. Crico- and laryngotracheal resection and laryngotracheal reconstruction-usually with autologous cartilage graft implantation-are the most effective treatments. These surgical techniques are obviously challenging in neonatal age and infancy. However, a reconstructive surgery performed at early age may prevent the sequel of complications.

Methods: The authors present their novel surgical method for congenital subglottic stenosis. Seven infants had inspiratory stridor; two of them had to be intubated and one required tracheostomy. Laryngotracheoscopy, CT or MRI revealed subglottic stenosis: Cotton-Myer grade II in one, and grade III in six cases. Slide laryngotracheoplasty was performed before 5 months of age (10-130 days), with a follow-up period of average 36 months (4-80 months). Phoniatry and quality of life questionnaire were used for evaluation of postoperative results.

Results: Slide laryngotracheoplasty in the neonatal age made the temporary tracheostomy unnecessary. All babies remained intubated for 3 to 10 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts showed satisfactory functional results.

Conclusions: Single-stage slide laryngotracheoplasty might be a favorable solution for subglottic stenosis, even in early childhood. In one step, the airway can be maintained without stenting and tracheostomy.

Level Of Evidence: 4 Laryngoscope, 130:E199-E205, 2020.
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http://dx.doi.org/10.1002/lary.28192DOI Listing
April 2020

Combined use of Ventrain and S-Guide for Airway Management of Severe Subglottic Stenosis.

Turk J Anaesthesiol Reanim 2019 Jun 19;47(3):238-241. Epub 2019 Feb 19.

Department of Anaesthesiology, CHUV - University Hospital of Lausanne, Lausanne, Switzerland.

The airway management of a patient with severe tracheal stenosis depends on its severity, length, location, and type of surgery. Its management is complex and requires the collaboration of an experienced team of anaesthetist and ear, nose, and throat surgeon. We report an innovative combination of Ventrain™ and S-Guide™ for airway management of a planned endoscopic dilation of a severe subglottic stenosis in an adult patient. This new alternative may offer advantages over existing airway management techniques in similar cases.
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http://dx.doi.org/10.5152/TJAR.2019.75428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537953PMC
June 2019

Transoral robotic-assisted supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Procedure development and outcomes of initial cases.

Head Neck 2018 10 22;40(10):2254-2262. Epub 2018 Jun 22.

Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Suisse.

Background: We report on the feasibility and functional outcome of transoral robotic (TORS) supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP).

Methods: Cadaveric studies and functional outcome at 3 years using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-H&N35), the Functional Outcome Swallowing Scale (FOSS), the Performance Status Scale for Head and Neck Cancer (PSS-HN), computerized voice analysis, and videotape recordings. Data were compared with a historical cohort of open CHEPs/cricohyoidopexies (CHPs).

Results: The EORTC-QLQ-H&N35 scores, FOSS scores, and PSS-HN scores at 3 years of 2 operated patients were 46 and 43, 2 and 1, and 75 of 100 (eating in public) and 100 of 100 (normalcy of diet), respectively. The mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) were 85 HZ and 81 Hz, 8.52% and 6.39%, 28.2% and 13.5%, 0.61 and 0.71, 19 seconds and 15 seconds, respectively.

Conclusion: Functional outcome data suggest that the procedure is feasible and safe.
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http://dx.doi.org/10.1002/hed.25332DOI Listing
October 2018

Lamb larynx model for training in endoscopic and CO laser-assisted surgeries for benign laryngotracheal obstructions.

Eur Arch Otorhinolaryngol 2018 Aug 4;275(8):2061-2069. Epub 2018 Jun 4.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Bugnon 46, 1011, Lausanne, Switzerland.

Purpose: With adequate indication and meticulous execution, endoscopic procedures can efficiently treat a subset of adult and pediatric benign laryngotracheal stenosis and obstructions, but these procedures are precise and very demanding. The difference between a successful and a failed surgery, with potentially debilitating side effects, resides in small details. The learning curve is long and very few centers worldwide have a sufficient case load making adequate training difficult. While indications and concepts of endoscopic procedures can be learned in books and by observing trained colleagues, the dexterity and the precise realization need to be practiced, ideally not initially on patients.

Methods: We describe here the lamb model system for the initial training in such procedures. We provide a step-by-step guide for endoscopic approaches intended to treat pathologies such as laryngomalacia, bilateral vocal fold paralysis, posterior glottic stenosis, and laryngotracheal clefts.

Conclusions: The lamb model system does not pose ethical issues, and it is easy to obtain and to handle. It was used during an international training course for laryngotracheal stenosis by novice and advanced airway surgeons. It was unanimously judged as relevant and useful by the participants.
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http://dx.doi.org/10.1007/s00405-018-5011-7DOI Listing
August 2018

Anesthetic Management for Concomitant Correction of Congenital Cardiac Defects and Long "O" Ring Tracheal Stenosis: A Role for Heliox?: Report of 2 Cases.

A A Pract 2018 Mar;10(6):154-156

From the Departments of Pediatric Anesthesia, Pediatric Intensive Care, Cardiovascular Surgery, Otorhinolaryngology, and Pediatric Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

We present 2 infants with the rare association of long congenital tracheal stenosis, ventricular septal defect, and pulmonary hypertension. We describe a step-by-step assessment of the patients and the necessary procedures for a successful concomitant repair of both cardiac and tracheal malformations. The use of a helium-oxygen mixture (heliox) for the induction of anesthesia and pre-cardiopulmonary bypass is discussed.
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http://dx.doi.org/10.1213/XAA.0000000000000733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862009PMC
March 2018

Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO laser approach.

Int J Pediatr Otorhinolaryngol 2017 Nov 3;102:123-126. Epub 2017 Aug 3.

Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland.

Importance: Oesophageal inlet stenosis can promote dysphagia and aspiration. We report the cases of syndromic children with congenital pharyngeal webs successfully treated with endoscopic CO2 laser.

Observations: Pharyngeal webs were excised with CO2 laser (Ultrapulse mode) and resurfaced using mucosal advancement flaps to avoid restenosis and/or formation of secondary synechia. This led to a significant enlargement of the oesophageal inlet, which was documented immediately postoperatively and the clinical improvement of dysphagia and decreased aspiration persisted at distant follow-up.

Conclusion And Relevance: Pharyngeal webs are congenital anomalies that can be safely and effectively corrected with endoscopic treatment.
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http://dx.doi.org/10.1016/j.ijporl.2017.08.001DOI Listing
November 2017

Temporary tracheal stenting using endovascular prosthesis in the management of severe refractory stenosis following slide tracheoplasty.

Eur Arch Otorhinolaryngol 2018 Jan 26;275(1):275-280. Epub 2017 Oct 26.

Department of Otorhinolaryngology, Lausanne University Hospital, 1005, Lausanne, Switzerland.

Objectives: To evaluate the role of endovascular stents in temporary tracheal stenting and endoscopic treatment strategy for patients with severe refractory tracheal stenosis following slide tracheoplasty.

Methods: Two patients had severe tracheal stenosis after slide tracheoplasty for long segment congenital tracheal stenosis. Both these patients were managed endoscopically and an endovascular prosthesis was used to temporarily stent the trachea. Short and long term results were evaluated clinically and with repeated endoscopies.

Results: The 2 patients had an excellent recovery immediately after the stent placement and continue to have an optimal, age-appropriate stable tracheal diameter after stent removal.

Conclusion: Endovascular stents can be temporarily used to stent the trachea in the endoscopic treatment strategy to correct refractory severe tracheal stenosis following slide tracheoplasty.
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http://dx.doi.org/10.1007/s00405-017-4792-4DOI Listing
January 2018

Refashioned lamb tissue as an animal model for training complex techniques of laryngotracheal stenosis surgery.

Eur Arch Otorhinolaryngol 2017 Dec 16;274(12):4169-4181. Epub 2017 Oct 16.

Department of Otorhinolaryngology, Head and Neck Surgery, Lausanne's University Hospital, CHUV, Lausanne, 1011, Switzerland.

Open reconstructive upper airway surgery for laryngotracheal stenosis (LTS), whether for subglottic or tracheal stenosis, constitutes a group of complex approaches. LTS requiring open reconstruction is overall rare and primarily performed at tertiary centres. This poses an obvious challenge for the acquisition and maintenance of surgical skills for this group of complex approaches. In this context, animal models provide a unique opportunity for open reconstructive airway surgery training. Such models ought to take into consideration ethical aspects, be easily available and easy to maintain, and have similar macroscopic anatomical features to the human laryngotracheal frame. Here, we provide a brief surgical guide for the use of refashioned lamb tissue as a training model for surgery of adult and pediatric reconstructive airway surgery. The techniques of laryngotracheal reconstruction, partial cricotracheal resection, tracheal resection with end-to-end anastomosis, and slide tracheoplasty are presented. Proper training in open LTS surgery is challenging, time consuming and its complexity further lengthens the learning curve. The lamb larynx and trachea model is an effective model for practising various airway reclaiming surgeries.
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http://dx.doi.org/10.1007/s00405-017-4775-5DOI Listing
December 2017

Extraluminal biodegradable splint to treat upper airway anterior malacia: A preclinical proof of principle.

Laryngoscope 2018 02 16;128(2):E53-E58. Epub 2017 Sep 16.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Objective: Upper airway malacia highly complicates the treatment of benign laryngotracheal stenosis, and no ideal option is available to date. We here explore the use of extraluminal biodegradable splints in an animal model of long-segment anterior tracheomalacia (TM). We show the efficacy, as well as the tissue tolerance, of a custom-made biodegradable extraluminal device surgically inserted around the trachea.

Study Design: Preclinical animal study.

Methods: Anterior TM was induced in rabbits through an anterior neck approach by removing eight consecutive anterior tracheal rings without damaging the underlying mucosa. Malacia was corrected during the same surgery by pexy sutures, suspending the tracheal mucosa to an experimental biodegradable device. Symptoms, survival, and tissue reaction were compared to healthy and sham surgery controls.

Results: The model induced death by respiratory failure within minutes. Ten animals received the experimental treatment, and those who survived the perioperative period remained asymptomatic with a maximum follow-up of 221 days. Histological studies at programmed euthanasia showed complete degradation of the prosthesis, with significant remnant fibrosis around the trachea. However, the tracheal stiffness of test segments was comparatively less than that of control segments.

Conclusion: Extraluminal biodegradable splints rescued animals with a condition otherwise incompatible with life. It was well tolerated, leaving peritracheal fibrosis that was not as stiff as normal trachea. The external tracheal stiffening was sufficient for the test animals to live through the phase of severe acute hypercollapsibility. This represents a valid option to help pediatric patients with laryngotracheal stenosis and associated cartilaginous airway malacia.

Level Of Evidence: NA. Laryngoscope, 128:E53-E58, 2018.
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http://dx.doi.org/10.1002/lary.26857DOI Listing
February 2018

Complicated Postoperative Course after Pulmonary Artery Sling Repair and Slide Tracheoplasty.

Front Pediatr 2017 10;5:67. Epub 2017 Apr 10.

Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland.

Pulmonary artery sling (PAS) is a rare congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery, and then passes between the trachea and the esophagus to reach the left lung, thereby forming a sling around the airway. It is often associated with intrinsic tracheal stenosis due to complete cartilaginous rings. Therapeutic management nowadays consists of one-stage reimplantation of the LPA and tracheoplasty with cardiopulmonary bypass support. Here, we present a 7-week-old boy with PAS and long-segment tracheal stenosis (LSTS) who underwent surgical intervention consisting of reimplantation of the LPA and slide tracheoplasty. Multiple respiratory and cardiovascular complications marked the postoperative course. They consisted of recurrent failed attempts in weaning off mechanical ventilation due to bronchomalacia, left vocal cord paralysis, development of granulation tissue at the anastomosis and restenosis of the trachea, and the main stem bronchi requiring balloon dilatation. The patient also developed bilateral pulmonary artery thrombosis and stenosis of the LPA. After a prolonged hospitalization, the patient is doing well without any respiratory symptoms and has a good result on follow-up bronchoscopy 1 year after the initial surgery. The stenosis of the LPA responded well to percutaneous balloon dilatation 12 months after the primary surgery. The case illustrates that even though surgical techniques are improving and are in general associated with a low morbidity and mortality, management of PAS and tracheal stenosis can still be challenging. However, good long-term outcome can be achieved if the initial postoperative phase is overcome.
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http://dx.doi.org/10.3389/fped.2017.00067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385459PMC
April 2017

Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions.

Plast Reconstr Surg Glob Open 2016 Oct 27;4(10):e1013. Epub 2016 Oct 27.

Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.

Background: Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome-related parameters.

Methods: Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications.

Results: A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations ( < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9-3.5; = 0.000), high-volume versus low-volume surgeon (OR = 0.52; CI = -0.22 to 0.82; = 0.007), and ASA classification (OR = 2.9; CI = 2.4-3.4; = 0.033) were retained as independent predictors of severe complications. In a Cox-regression model, surgeon ( = 0.011), site of reconstruction ( = 0.000), T-stage ( = 0.001), and presence of severe complications ( = 0.015) correlated with a prolonged hospitalization.

Conclusions: In this study, we identified a correlation of patient-related factors with severe complications (ASA score) and prolonged hospital stay (T-stage, site). More importantly, we identified several provider- (surgeon) and volume-related (frequency with which a flap was performed and high-volume surgeon) factors as predictors of severe complications. Our data indicate that provider- and volume-related parameters play an important role in the outcome of microvascular free-flap procedures in the head and neck region.
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http://dx.doi.org/10.1097/GOX.0000000000001013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096513PMC
October 2016

External bioresorbable airway rigidification to treat refractory localized tracheomalacia.

Laryngoscope 2016 11 12;126(11):2605-2610. Epub 2016 Mar 12.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Objectives/hypothesis: Our study evaluates the efficacy of extraluminal bioresorbable plates to treat refractory localized airway malacia in patients undergoing corrective surgery for complex multilevel laryngotracheal stenosis.

Study Design: Retrospective case series.

Methods: Secondary malacic airway segments were characterized (severity, site, type) by a dynamic transnasal flexible laryngotracheobronchoscopy before surgery. Extraluminal bioresorbable plates were used to stabilize the malacic segment through a transcervical approach under intraoperative flexible endoscopic guidance. Results were evaluated subjectively and by a postoperative dynamic endoscopy. We report our experience in seven patients (6 children, 1 adult).

Results: External tracheal stiffening allowed complete or partial resolution of refractory proximal airway malacia in six of seven complex cases described (result in one case is awaited). It allowed quick decannulation in four of seven patients who experienced multiple previous failures. Decannulation failures were due to recurrence of stenosis. With up to 2 years of follow-up, we report no direct complications related to the presence of extraluminal bioresorbable plates around the airway.

Conclusion: Extraluminal biodegradable tracheal stiffening represents a valid therapeutic option in select cases of upper airway malacia. It can be highly useful in cases of complex multilevel airway obstructions. External stiffening needs to be planned on a case-to-case basis according to the type of malacia and must be performed under endoscopic guidance.

Level Of Evidence: 4. Laryngoscope, 126:2605-2610, 2016.
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http://dx.doi.org/10.1002/lary.25918DOI Listing
November 2016

Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center.

Eur Arch Otorhinolaryngol 2017 Jan 13;274(1):367-374. Epub 2016 Aug 13.

Department of Otorhinolaryngology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

To review the outcomes of laser supraglottoplasty performed in children with symptomatic laryngomalacia and determine the factors influencing them. We retrospectively reviewed the medical records of patients who underwent laser supraglottoplasty for symptomatic laryngomalacia at the Lausanne University Hospital from November 2001 to November 2014. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes. Seventy-nine patients were included in this study; median age at the time of surgery was 12.7 months. 55.7 % of the cases had comorbidities, 22.8 % of the patients were premature and synchronous airway lesions were present in 32.9 % of the cases. The different morphological types of laryngomalacia (I-III) were seen in 26.6, 62 and 11.4 % of the patients, respectively. Overall, operation specific success rate of laser supraglottoplasty was 86.1 %. Failures in 11 (13.9 %) of the 79 cases required 15 revision procedures. Success rates for patients with associated comorbidities, synchronous airway lesions, neurological disorders and prematurity were 81.8, 76.9, 69.2 and 66.7 %, respectively. Patients with type III laryngomalacia had a limited success rate (66.7 %) as compared to patients with morphological types I and II (90.5 and 87.8 %, respectively). Laser supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia. Patients with prematurity, type III LM, synchronous airway lesions and associated comorbidities are predisposed to surgical failure.
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http://dx.doi.org/10.1007/s00405-016-4252-6DOI Listing
January 2017

Endoscopic epiglottopexy using Lichtenberger's needle carrier to avoid breakdown of repair.

Eur Arch Otorhinolaryngol 2015 Nov 11;272(11):3385-90. Epub 2015 Jul 11.

Department of Otolaryngology, University Hospital, Lausanne, Switzerland.

Severe type III laryngomalacia LM is represented by a retroflexed epiglottis that touches the posterior pharyngeal wall and obstructs the laryngeal inlet. Endoscopic epiglottopexy is advised in such cases wherein pexy sutures are passed between the epiglottis and base of tongue. Using conventional needle carriers, it is difficult to pass such sutures that go deep enough into the tongue base. Such a pexy is prone to a break down. We describe a novel technique of placing these glossoepiglottic sutures using the Lichtenberger's needle carrier. We used this technique in three patients with excellent results and report no complications. We propose to use this technique in cases of epiglottic prolapse seen in severe LM and certain hypotonic conditions.
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http://dx.doi.org/10.1007/s00405-015-3707-5DOI Listing
November 2015

Single stage transforaminal retrojugular tumor resection: The spinal keyhole for dumbbell tumors in the cervical spine.

Surg Neurol Int 2015 1;6:53. Epub 2015 Apr 1.

Neurosurgical Service, Department of Clinical Neurosciences, University of Lausanne Hospital, CHUV, Lausanne, Switzerland.

Background: Dumbbell tumors are defined as having an intradural and extradural component with an intermediate component within an expanded neural foramen. Complete resection of these lesions in the subaxial cervical spine is a challenge, and it has been achieved through a combined posterior/anterior or anterolateral approach. This study describes a single stage transforaminal retrojugular (TFR) approach for dumbbell tumors resection in the cervical spine.

Methods: This is a retrospective review of a series of 17 patients treated for cervical benign tumors, 4 of which were "true" cervical dumbbell tumors operated by a simplified retrojugular approach. The TFR approach allows a single stage gross total resection of both the extraspinal and intraspinal/intradural components of the tumor, taking advantage of the expanded neural foramen. All patients were followed clinically and radiologically with magnetic resonance imaging (MRI).

Results: Gross total resection was confirmed in all four patients by postoperative MRI. Minimal to no bone resection was performed. No fusion procedure was performed and no delayed instability was seen. At follow up, one patient had a persistent mild hand weakness and Horners syndrome following resection of a hemangioblastoma of the C8 nerve root. The other three patients were neurologically normal.

Conclusions: The TFR approach appears to be a feasible surgical option for single stage resection in selective cases of dumbbell tumors of the cervical spine.
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http://dx.doi.org/10.4103/2152-7806.154453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395986PMC
April 2015

Thoracocervicofacial Emphysema after Heimlich's Maneuvre.

Case Rep Otolaryngol 2015 5;2015:427320. Epub 2015 Mar 5.

Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of Sion, 1950 Sion, Switzerland.

We report an extremely rare example of a thoracocervicofacial subcutaneous emphysema after Heimlich maneuver case.
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http://dx.doi.org/10.1155/2015/427320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357038PMC
March 2015

Residual fistula of fourth branchial arch anomalies and recurrent left-side cervical abscess: clinical case and review of the literature.

Case Rep Otolaryngol 2014 24;2014:931279. Epub 2014 Nov 24.

Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of Sion, 1950 Sion, Switzerland.

Congenital fourth branchial arch anomalies are uncommon entities. Most of these anomalies are diagnosed in childhood. The majority of cases occur on the left side. The clinical presentation of these anomalies varies with age. A respiratory distress is the usual clinical presentation in neonates, cervical cutaneous fistulas in late childhood or acute suppurative thyroiditis. Multiples diagnostic options have been described with different modalities of treatment. The majority of cases of fourth branchial arch anomalies are described only in case reports. We report a clinical case of recurrent cervical abscess in a young woman due to a residual fistula of fourth branchial arch.
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http://dx.doi.org/10.1155/2014/931279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259132PMC
December 2014

Clinicobiological progression and prognosis of oral squamous cell carcinoma in relation to the tumor invasive front: impact on prognosis.

Acta Otolaryngol 2014 Apr;134(4):416-24

Department of Otorhinolaryngology , Sion.

Conclusion: There are several factors that influence the final outcome when treating oral squamous cell carcinoma (OSCC). Invasive front phenomena and more importantly their clinicopathological translation can have a direct impact on survival, and subsequently on the decision for an adjuvant treatment.

Objectives: In recent years, the concept of tumor-host interaction has been the subject of substantial efforts in cancer research. Tumoral behavior may be better understood when studying the changes occurring at the tumor-host interface. This study evaluated the influence of several clinicopathological features on the outcome of OSCCs.

Methods: The clinical records and pathology specimens of 54 patients with OSCC treated by primary resection were reviewed retrospectively. The pathologic features reviewed were: invasive front grading (IFG), stromal reaction, lymphovascular invasion (LVI), perineural invasion (PNI), margin status, and depth of invasion.

Results: High IFGs had a significant relationship with pT status and pN status. High IFGs were strongly correlated with nodal metastases (odds ratio (OR) = 4.77; confidence interaval (CI) = 1.37-16.64). Concerning survival, IFG had a strong impact on disease-free survival in patients treated unimodally, as did the depth of invasion in the same group. Lymphovascular involvement was found to have a negative impact on overall survival in patients treated multimodally.
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http://dx.doi.org/10.3109/00016489.2013.849818DOI Listing
April 2014

Prolonged remission of juvenile-onset respiratory papillomatosis: a post-expositional role of the tetravalent anti-HPV vaccine?

Int J Pediatr Otorhinolaryngol 2014 Feb 19;78(2):388-90. Epub 2013 Dec 19.

Department of Otorhinlaryngology, Hôpital de Sion - CHCVs/RSV, Av. Grand Champsec 80, 1950 Sion, Switzerland. Electronic address:

Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an HPV-related neoplasm affecting primarily the larynx. JORRP often requires repeated surgical debridement, which yield variable but generally moderate remission periods. We report the case of a 6-year-old boy with severe course JORRP since the age of 2, requiring tracheostomy, that underwent prolonged remission and was decannulated some months after administration of the HPV vaccine. The post-exposure use for the anti-HPV vaccine in JORRP is a topic of capital interest but still poorly characterized. Some published cases suggest a potential post-exposure role of the vaccine in JORRP, but prospective multicentric trials are still needed.
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http://dx.doi.org/10.1016/j.ijporl.2013.12.013DOI Listing
February 2014

Cricotracheal resection for laryngeal invasion by thyroid carcinoma: our experience.

Eur Arch Otorhinolaryngol 2014 Aug 16;271(8):2261-6. Epub 2013 Oct 16.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital CHUV, Lausanne, Switzerland,

Invasion of the laryngeal framework by thyroid carcinoma requires specific surgical techniques and carries a higher rate of complications that deserve to be highlighted. We reviewed our data from 1995 to 2012 and found six patients with laryngotracheal invasion by thyroid carcinoma. All underwent total thyroidectomy and single-stage cricotracheal resection, plus anterolateral neck dissection. Three had airway obstruction that necessitated prior endoscopic debulking. None of the patients needed a tracheotomy. There were four cases of papillary carcinoma, and two cases of undifferentiated carcinoma. One patient died of complications of the procedure (anastomotic dehiscence and tracheo-innominate artery fistula). Another died 2 months after the procedure from local recurrence and aspiration pneumonia. One case presented recurrence at 15 months, which was managed by re-excision and adjuvant radiotherapy; after 26 months of follow-up, he has no evidence of locoregional recurrence. The three other patients are alive without evidence of disease at 6, 18 and 41 months, respectively. Cricotracheal resection for subglottic invasion by thyroid carcinoma is an effective procedure, but carries significant risks of complications. This could be attributed to the devascularisation of the tracheal wall due to the simultaneous neck dissection, sacrifice of the strap muscles or of a patch of oesophageal muscle layer. We advocate a sternocleidomastoid flap to cover the anastomosis. Cricotracheal resection for subglottic invasion can be curative with good functional outcomes, even for the advanced stages of thyroid cancer. Endoscopic debulking of the airway prior to the procedure avoids tracheotomy.
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http://dx.doi.org/10.1007/s00405-013-2757-9DOI Listing
August 2014

Correlation between subjective evaluation of symptoms and objective findings in early recurrent head and neck squamous cell carcinoma.

JAMA Otolaryngol Head Neck Surg 2013 Jul;139(7):687-93

Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital de Sion, Centre Hospitalier du Centre du Valais/Réseau Santé Valais, Sion, Switzerland.

Importance: This study addresses the value of patients' reported symptoms as markers of tumor recurrence after definitive therapy for head and neck squamous cell carcinoma.

Objective: To evaluate the correlation between patients' symptoms and objective findings in the diagnosis of local and/or regional recurrences of head and neck squamous cell carcinomas in the first 2 years of follow-up.

Design: Retrospective single-institution study of a prospectively collected database.

Setting: Regional hospital.

Participants: We reviewed the clinical records of patients treated for oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinomas between January 1, 2008, and December 31, 2009, with a minimum follow-up of 2 years.

Main Outcomes And Measures: Correlation between symptoms and oncologic status (recurrence vs remission) in the posttreatment period.

Results: Of the 101 patients included, 30 had recurrences. Pain, odynophagia, and dysphonia were independently correlated with recurrence (odds ratios, 16.07, 11.20, and 5.90, respectively; P < .001). New-onset symptoms had the best correlation with recurrences. Correlation was better between 6 to 12 and 18 to 21 months after therapy and in patients initially treated unimodally (P < .05). Primary stage and tumor site had no effect.

Conclusions And Relevance: The correlation between symptoms and oncologic status is low during substantial periods within the first 2 years of follow-up. New-onset symptoms, especially pain, odynophagia, or dysphonia, better correlate with tumor recurrence, especially in patients treated unimodally.
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http://dx.doi.org/10.1001/jamaoto.2013.3289DOI Listing
July 2013

Lymphoepithelial carcinoma in the maxillary sinus: a case report.

J Med Case Rep 2012 Dec 11;6:416. Epub 2012 Dec 11.

Department of ORL and Head and Neck surgery, CHUV, Lausanne, Switzerland.

Unlabelled:

Introduction: Lymphoepithelial carcinoma of the maxillary sinus is a very rare malignancy and it can be difficult to make a pre-operative diagnosis.

Case Presentation: A 72-year-old Caucasian woman presented to our facility with an isolated right-side epistaxis that had been present for three months, with the results of a computed tomography scan showing a soft tissue mass in the right maxillary sinus with an impacted tooth. The results of a transnasal endoscopic biopsy were compatible with a lymphoepithelial carcinoma, following which our patient underwent a radical excision of the mass. The final histology results revealed lymphoepithelial carcinoma of the maxillary sinus with negative assays for Epstein-Barr virus. Our patient was given post-operative external radiotherapy and has remained disease-free at three-year follow-up.

Conclusions: This report details the diagnosis and management of a case of lymphoepithelial carcinoma of the maxillary sinus, which is a very rare malignant tumor with very little mention in the literature. Only a strong suspicion with systematic use of various patho-immunological tests helps to arrive at a definitive diagnosis by excluding other better-known tumors.
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http://dx.doi.org/10.1186/1752-1947-6-416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522532PMC
December 2012